Childhood cancer survivors have increased cardiovascular disease burden
MedWire News: Childhood cancer survivors have significantly increased cardiovascular disease morbidity in young adulthood, shows the largest study to investigate the association to date.
The study of over 14,000 adult survivors of childhood and adolescent cancers found they were significantly more likely than siblings to report cardiac complications known to be related to cancer therapy, namely heart failure, pericardial disease, myocardial infarction, and valvular abnormalities.
The findings also indicated that increased risk for such cardiac conditions associated with anthracyclines and radiation therapy was apparent at lower doses of each than previously recognized.
While further research is needed to investigate whether screening such individuals for cardiovascular disease could be justified, healthcare professionals should be aware of the risks and monitor for these conditions when caring for the growing population of young adults who have survived cancer, say the study’s authors.
Daniel Mulrooney (University of Minnesota, Minneapolis, USA) and colleagues investigated the cardiac late effects of cancer therapy 5 or more years after diagnosis using data from the Childhood Cancer Survivor Study on 14,538 survivors of childhood cancer. These people had been diagnosed under the age of 21 years with leukemia, brain cancer, Hodgkin’s or non-Hodgkin’s lymphoma, kidney cancer, neuroblastoma, soft tissue carcinoma, or bone cancer between 1970 and 1986.
At enrolment in 1995–1996, the participants completed questionnaires including data on medical conditions and surgical procedures occurring since their diagnosis. For comparison, 3899 nearest-age siblings from a random sample of survivors also completed a questionnaire.
Mulrooney and team report in the British Medical Journal that the rate of cardiac events was low overall among cancer survivors, but excessive compared with that of siblings.
Heart failure was the most common first cardiac condition reported by cancer survivors, at 1.7% compared with 0.2% of siblings. Valvular abnormalities was the next most frequent in survivors (1.6% vs 0.5%), followed by pericardial disease (1.3% vs 0.3%), and myocardial infarction (0.7% vs 0.2%).
After adjusting for demographics, socioeconomic and education levels, and cardiac risk factors, cancer survivors had 6.3-, 5.9-, 5.0-, and 4.8-fold increased relative hazards for pericardial disease, heart failure, myocardial infarction, and valvular abnormalities, respectively.
Of note, the cumulative incidence of each outcome in survivors increased with increasing time from diagnosis. And multivariable analysis showed that the increased risks for most were associated with specific therapeutic exposures, notably to an anthracycline dose of less than 250 mg/m2 for heart failure, and cardiac radiation doses above 1500 cGy for all outcomes.
In an accompanying editorial, UK experts Meriel Jenney (Children’s Hospital for Wales, Cardiff) and Gill Levitt (Great Ormond Street Hospital, London) said that many survivors currently receive no formal follow-up in the UK and suggest that, with the number of adult survivors steadily rising, a cost effective approach may be “for children’s services that assess late effects to merge with adult services that provide a network of specialists with expertise in this area.”
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By Caroline Price